1386607000 NPI number — ROY E TULLER DO

Table of content: ROY E TULLER DO (NPI 1386607000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386607000 NPI number — ROY E TULLER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TULLER
Provider First Name:
ROY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386607000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-4093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6144
Provider Business Mailing Address Fax Number:
570-271-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 ROUTE 220 HWY STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17756-7569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-321-0880
Provider Business Practice Location Address Fax Number:
570-321-8012
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  OS009835L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007386239 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2153242 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 816741 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001938093 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019380930003 . This is a "MEDICAID MUNCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 321821 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 76917-5365 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 036635 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 180046237 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 385321 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019380930007 . This is a "MEDICAID LEWISBURG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 059444767 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 436635 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019380930002 . This is a "MEDICAID DUBOIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50010412 . This is a "CAPITAL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019380930005 . This is a "MEDICAID WILLIAMSPORT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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